| NPI | 1053545285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A95140) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A95140) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2022-02-11 |